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| Future of Medical Transcription |
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| Other factors that lead the industry in general and clinicians in particular
to respond to the appeal of alternatives to medical transcription include: |
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Impact on continuity and
quality of care : Turn-around
time, control and access,
and quality issues in particular
can impact quality and continuity
of care. Without the most
accurate current, as well
as past, relevant documentation
available at the time a
patient is assessed and
treated, medical decision-making
is handicapped. Incomplete
and/or inaccurate documentation
can lead to wrong diagnoses
and medications, as well
as repeat tests and procedures
and thus increased costs.
Continuity of care demands
that current, complete,
accurate information be
readily, easily available.
Certainly, modern-day medical
transcription is taking
steps to close the gaps
of delayed TAT and inadequate
control and access, but
it does not yet meet the
potential that real-time,
point-of-care documentation
that EMRs offer through
alternative information
capture means. |
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The new generation of clinicians and
other healthcare providers
: This new population is
frustrated by and resistant
to techniques (including
medical transcription and
back-end speech recognition)
that don’t give them
real-time, point-of-care
access to, capture of, and
transmission of patient
data. For some, this means
keyboarding (which they’ve
been doing since childhood),
while others select alternative
direct entry means, including
point-and-click, pull-down
menus, templates, etc. Still
others have perfected front-end
speech recognition and/or
handwriting recognition
techniques. Indeed, hybrids
of two or more of these
direct entry options are
increasingly attractive
and adopted. MRI’s
2007 Survey of EMR Trends
& Usage reports that
the following methods are
most cited as being used
(as well as being used more
frequently) for entering
clinical information into
the EMR: |
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Free text keyboard entry |
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Structured data with pull-down menus |
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Structured data with keyboard/mouse. The survey also reports that
medical transcription is cited both as the most satisfactory and as the most unsatisfactory information capture
technique. Further, among survey respondents, the majority of those using SR
reported use only front-end SR with no medical transcriptionist, medical
editor, or other person involved.10 |
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Data vs documents : The CCR (Continuity
of Care Record)11 is a core
data set of the most relevant
current and past information
about a patient’s
healthcare status and treatment.
It was developed by consensus
through the co-sponsorship
of a leading standards development
organization (ASTM), medical
societies (American Medical
Association, Massachusetts
Medical Society, American
Academy of Family Physicians,
American Academy of Pediatrics),
and other organizations,
and it is being increasingly
widely adopted in clinical
environments. The CCR represents
a shift from relying on
documents from which relevant
patient data must be searched
and derived to focusing
on the data themselves,
thereby facilitating and
accelerating access to key
patient information and
in turn contributing to
improved quality and continuity
of care and diminished medical
errors and healthcare costs.
With the CCR, relevant data
are immediately accessible,
and because the source of
each data element is identified,
the next provider can assess
the reliability of the data
and quickly determine where
follow up and further investigation
are necessary.
While documents
(transcribed and otherwise) will continue to be predominant in healthcare for
some time to come, there is the beginning of a move away from story telling
(sentences, paragraphs, reports), which results in documentation that requires
searching for and pulling essential data, toward documenting the data
directly, and then when documents are needed, using the data to populate
consensus-designed templates. Though not initiated in response to this shift
from a “documents then data” to a “data then documents” approach, the
collaborative work being done by AHDI, AHIMA, and MTIA with HL7 to standardize
the most common clinical documents12 will be especially helpful in facilitating
the transformation of recorded data into standard formats for H&Ps,
consultations, operative reports, etc. |
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Mobile technologies : The rise
of the modern cell phone
as a portable, powerful
computing and communication
device will change information
capture again. The younger
(and much of the older)
generation of physicians
already uses cell phones
for a wide range of applications,
as do more and more patients
and their children. These
point-of-care computing
devices enable easy access
to data, decision support
functions and documentation,
whether by voice (with or
without speech recognition)
or direct input (stylus,
phone keyboard, touch screen,
etc.). The cell phone may
represent the next wave
of computer interaction
using the data approach
described above. A strong
market for using the cell
phone to dictate will persist
for some time, provided
the dictation is transcribed
rapidly and correctly, whether
through speech recognition
(back-end or front-end)
or traditional transcription. |
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| Given all the
above factors, it may be too late for medical transcription to be the strongest solution to EMR adoption, but the more it evolves to keep up
with EMR potentials, the greater contribution it can make and the greater
benefits it can gain. Long gone are the days when the transcription industry can
“dictate” that originators adapt to their equipment, requirements, and
limitations. It is past time for transcription and other documentation methods
to be responsive to the needs of the healthcare community and of patients
themselves, and there are signs that this is beginning to happen. This means the
medical transcription industry must more widely |
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Work cooperatively with EMR vendors to enable transcription to routinely
be among options for information capture. Much of the movement in this
direction is proprietary, i.e., a particular medical transcription service is
linked to a particular brand of EMR. What is needed is the ability for any
medical transcription service or department to be linked to any EMR. |
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Integrate transcription into cost-effective hybrid solutions that better
enable point-of-care, real-time documentation. As in the previous point, this
hybrid integration must be available in any EMR. |
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Offer medical transcription of not just free text, but also structured and
semi-structured dictation, including the Continuity of Care Record. Progress
toward structured text is being made by transcription companies that offer
xml-based solutions supporting structured transcription, allowing data to be
more readily retrieved. Some companies already offer CCR generation as a
value-added service. For both structured text in general and the CCR in
particular, more universally interoperable transcription standards are needed. |
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Offer training and support for speech recognition, both back-end and
front-end. Back-end SR is more and more common and will likely expand. Greater
efforts toward facilitating front-end SR are awaiting a symbiosis between
transcription companies and EMR vendors and SR systems. |
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Prepare for and contribute to the design of dynamic evolutionary processes
for information capture that look toward opportunities of benefit to
healthcare and not toward preservation of the status quo. This includes
working with MTs to improve the quality of their transcription and preparing
them for alternative career paths in patient care documentation. The evolution
toward EMRs and computer-based, computer-supported healthcare delivery is
inevitable, and the reaction must shift away from perceiving this as a threat
to the medical transcription industry and MTs. Instead, it must be recognized
as an opportunity for the industry to evolve into a new field with new
opportunities and for the most talented MTs to utilize their special expertise
and abilities in ways that are stimulating and productive to them, e.g., as
scribes, documentation compliance officers, and decision support specialists,
and that also bring increasing value to healthcare delivery. |
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Predictions were made – and widely believed – back in the mid-1980s that
speech recognition would lead to the demise of traditional medical transcription
within 5 to 10 years. In the more than 25 intervening years, medical
transcription has grown substantially, becoming a major force in the healthcare
documentation industry, and it will likely remain so for some time to come,
perhaps for another 5 to 10 years, perhaps longer. But ultimately, this
industry’s high-ranking place among information capture options will not be
sustained as point-of-care, real-time documentation becomes simplified and its
benefits not only expected but demanded. In the distant past, healthcare
providers did their own documentation without a support group to help. Today the
trend is toward adopting easy-to-manage documentation systems that do not put a
burden in time or effort on the clinician, do not require transcription or other
support, and provide real-time and remote access to, entry of, and transmission
of patient information. The question remains, however, just how long it will
take for such systems to be perfected and have wide adoption. The medical
transcription industry could choose to contribute to its being sooner rather
than later, while at the same time stimulating its own metamorphosis into
something more valuable to healthcare.
Author’s note: For a real-life case study of how a major medical center
has adopted direct-entry noting, almost totally eliminating transcription, see
the interview in this issue titled “Improving Documentation and Saving Costs
Through Direct-entry Notes: An EMR Case Study.” |
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| Footnotes:
1 “Transcription Turnaround Time for Common Documentation Types,”
Joint Task Force on Standards Development, American Health Information
Management Association and Medical Transcription Industry Association. 11.
(August, 2008)
2 US Department
of Labor, Bureau of Labor Statistics (August, 2008)
3 “2007 Survey of Medical Transcriptionists: Preliminary
Findings,” Bentley College Healthcare Documentation Production Project. 5.
(August, 2008)
4 Transcription Turnaround Time for Common Documentation Types,
4. (August, 2008)
5 Ibid. 4
6 Ibid. 6
7 Medical Records Institute’s Ninth Annual Survey of Electronic
Medical Records Trends & Usage (co-sponsored by Philips Speech
Recognition Systems), 2007. (August, 2008)
8 “Analysis of Current Work Practices in Medical Transcription:
Findings and Recommendations” and “Compensation for Medical
Transcriptionists”, Hay Management Group, AAMT. 1999. (August, 2008)
9 Statement on Credentialing for
Healthcare Documentation Workers, MTIA. http://www.mtia.com/downloads/StatementonCredentialingforHealthcareDocumentation
Workers.pdf (August, 2008)
10 http://www.medrecinst.com/HITResources/EMRSurvey.php
11 ASTM International E2369-05 Continuity of Care
Record Standard, 2005.
12 Interoperability for Electronic Clinical
Documents, MTIA, 2007. http://www.mtia.com/downloads/PressRelease092507.pdf (August,
2008) |
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